Mood Stabilisers - Dr Jonathan Haverkampf

Medication and diagnosis safety note

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Diagnosis needs a real assessment

Mood stabilisers are usually considered in the context of a careful assessment of mood episodes, depression, mania or hypomania, sleep, risk, physical health, pregnancy potential, and previous treatment response.

Medication decisions need a prescriber

Medicines described as mood stabilisers can require monitoring, blood tests, pregnancy-related precautions, interaction checks, and careful plans for starting, continuing, switching, or stopping. Do not change them without prescriber guidance.

Do not start, stop, pause, increase, reduce, combine, switch, or restart medication because of something on this website. Discuss medication questions with a GP, psychiatrist, pharmacist, or another qualified prescriber who can consider your diagnosis, physical health, other medicines, substance use, pregnancy or breastfeeding, risks, and preferences.

When to use urgent help

Use urgent medical or emergency help for overdose concerns, severe allergic reaction, seizures, chest pain, fainting, severe confusion, symptoms of serotonin syndrome, dangerous withdrawal symptoms, new mania or psychosis, severe agitation, or thoughts of harming yourself or someone else. In Ireland call 112 or 999, or go to the nearest Emergency Department. Outside Ireland, use your local emergency number.

Sources checked for this safety note

Mood stabilisers help stabilise pronounced and prolonged mood shifts, which include hypomanic or manic phases, such as in bipolar disorder I and II. They can also help to a varying degree against depressive episodes as part of a bipolar disorder.

Lithium

The precise mechanism of action of lithium is unknown, and it is suspected that it acts at various points of the neuron between the nucleus and the synapse. The effect of lithium is probably due to the similar properties of lithium ions to potassium ions. In the synapse, lithium decreases norepinephrine release and increases serotonin synthesis.

Lithium is known to inhibit the enzyme GSK-3B, which may increase gene transcription of brain-derived neurotrophic factor (BDNF) and contribute to a better functioning of the circadian rhythm. The possible increased neural plasticity due to an increase in BDNF might also play a role.

Anticonvulsants

Anticonvulsants have inhibitory effects. They mostly block voltage-gated sodium channels, affecting the brain’s glutamate system (which is mainly excitatory), while some may have their main effect on the GABAergic system (which is mainly inhibitory).

Both, lithium and the anticonvulsants, probably have an effect on the arachidonic acid cascade, which plays a role in inflammatory responses, which may also affect mood.

Antipsychotics

Antipsychotics work primarily by changing the dopamine transmission. This can either directly or indirectly lead to mood stabilisation.

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